Fun on the Fourth!

July 4th @ 7pm - 8930 Larkin Road in Live Oak

Kids Parade: Parents: have your kids patriotically decorate their wagon, bike, scooter, tricycle or just about anything they want on non-motorized wheels! We will have a big parade around the property. Prizes will be given for best decorations!

Swimming: have kids bring swim gear if they want to get in the pool!MUST FILL OUT WAIVER BELOW TO PARTICIPATE IN EVENTS

We will also have safe/legal fireworks, free popcorn and sno-cones, and other snacks.

Once it gets dark we will have an outdoor movie projected onto the barn. Safe for the family. But fun for all! IMPORTANT: BRING YOUR OWN LAWN CHAIRS AND/OR BLANKET

This is a great, casual opportunity to bring a friend and meet some new friends!!REGISTER BELOW

REGISTRATION & WAIVERS

Download and fill out the liability release form below and bring to the event OR fill out the electronic registration below.

Fun on the Fourth Liability Waiver

* Indicates required field

Name: this constitutes a signature for the waiver (see by clicking on question mark to right) *

First

Last

I [NAME] have voluntarily agreed to attend events and activities at
8930 Larkin Road, Live Oak, CA 95953 and/or 700 Washington Avenue, Yuba City, CA 95991.
All persons attending any event or activity at the above address are deemed to have waived all claims against Jason
Poling, Gwen Poling and their family, Cornerstone Church of Yuba City, including any staff, Board Members and
paid or volunteer workers for injury, accident, illness, or death, occurring during, or by reason of, the event or
activities.
I have read and understand the foregoing statement agreeing to assume the responsibility stated and waive all claims
as indicated. A copy of this document carries the same validity as the original.

Date *

Cell Phone Number *

Emergency Phone Number (if different from cell) *

List Names of All Minor Children (if no children, input "No Minors") *

​Photography Disclaimer: From time to time, Cornerstone Church or its ministries and ministers record, photograph, and/or stream ministry events and church activities for both archival and promotional purposes. Your presence on our campus, and at our off-campus events, gives Cornerstone Church and its ministries permission to use attendee’s voice and image in any such archival or promotional recording, photograph, or streaming activity.

Fun on the Fourth!

July 4th @ 7pm - 8930 Larkin Road in Live Oak

Kids Parade: Parents: have your kids patriotically decorate their wagon, bike, scooter, tricycle or just about anything they want on non-motorized wheels! We will have a big parade around the property. Prizes will be given for best decorations!

Swimming: have kids bring swim gear if they want to get in the pool!MUST FILL OUT WAIVER BELOW TO PARTICIPATE IN EVENTS

We will also have safe/legal fireworks, free popcorn and sno-cones, and other snacks.

Once it gets dark we will have an outdoor movie projected onto the barn. Safe for the family. But fun for all! IMPORTANT: BRING YOUR OWN LAWN CHAIRS AND/OR BLANKET

This is a great, casual opportunity to bring a friend and meet some new friends!!REGISTER BELOW

REGISTRATION & WAIVERS

Download and fill out the liability release form below and bring to the event OR fill out the electronic registration below.

Fun on the Fourth Liability Waiver

* Indicates required field

Name: this constitutes a signature for the waiver (see by clicking on question mark to right) *

First

Last

I [NAME] have voluntarily agreed to attend events and activities at
8930 Larkin Road, Live Oak, CA 95953 and/or 700 Washington Avenue, Yuba City, CA 95991.
All persons attending any event or activity at the above address are deemed to have waived all claims against Jason
Poling, Gwen Poling and their family, Cornerstone Church of Yuba City, including any staff, Board Members and
paid or volunteer workers for injury, accident, illness, or death, occurring during, or by reason of, the event or
activities.
I have read and understand the foregoing statement agreeing to assume the responsibility stated and waive all claims
as indicated. A copy of this document carries the same validity as the original.

Date *

Cell Phone Number *

Emergency Phone Number (if different from cell) *

List Names of All Minor Children (if no children, input "No Minors") *

​Photography Disclaimer: From time to time, Cornerstone Church or its ministries and ministers record, photograph, and/or stream ministry events and church activities for both archival and promotional purposes. Your presence on our campus, and at our off-campus events, gives Cornerstone Church and its ministries permission to use attendee’s voice and image in any such archival or promotional recording, photograph, or streaming activity.